Procedural terminology manuals for physicians have been published by the AMA since 1966. Now for the first time, the AMA's just released procedural terminology manual (CPT 1997, fourth edition) includes identification codes to be used specifically by doctors of chiropractic.
One can't help but wonder about the feelings of AMA members that the CPT editorial panel elected to include chiropractic manipulative treatment (CMT) codes. After all, it has been less than a decade since the AMA was found guilty of trying to "contain and eliminate" the chiropractic profession.
The CMT codes are the work of chiropractors Jerilynn Kaibel and Craig Little. Dr. Little is the American Chiropractic Association's representative to the CPT/HCPAC (Health Care Professional Advisory Committee), which develops all codes. Dr. Kaibel is the ACA representative to the RUC (Relative Value Update Committee)/HCPAC, which places a reimbursement value on the all codes.
Looking through the index, one finds the listing "Chiropractic Treatment" for codes 98940-98943. These codes, listed on page 392, read as follows:
CHIROPRACTIC MANIPULATIVE TREATMENT
"Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. This treatment may be accomplished using a variety of techniques.
The chiropractic manipulative treatment codes include a pre-manipulation patient assessment. Additional Evaluation and Management services may be reported separately using the modifier-25, if and only if the patient's condition requires a significant separately identifiable E/M service, above and beyond the usual preservice and postservice work associated with the procedure.
For purposes of CMT, the five spinal regions referred to are: cervical region (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region. The five extraspinal regions referred to are: head (including temporomandibular joint, excluding atlanto-occipital) region; lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints) and abdomen.
- 98940 - Chiropractic manipulative treatment (CMT); spinal, one to two regions.
- 98941 - spinal, three to four regions.
- 98942 - spinal, five regions 98943 extraspinal, one or more regions.
While the reimbursement values will not be available until after the November elections (be watching next issue), the CMT codes do provide some immediate relief on the issue of E/M codes. As stated in the preamble (second paragraph), chiropractors may report additional E/M services as required. This should begin to settle the argument with a number of insurance carriers.
Dr. Kaibel points to the advancements chiropractic is making: "In less than two years we have been included in CPT coding and are now beginning to see the playing field level."
